What should I do?

[mercaptovizadeh]

For those in MD/PhD programs and beyond, what would you suggest as a course of study/extracurriculars during the MD/PhD years. What factors are most important for getting an excellent residency? What would you suggest for each of the years of study? In particular, what kind of extracurriculars, volunteering, shadowing, or leadership were you involved in during the MS 1 and 2 years and the PhD years? How important are these towards the application? How important are AOA and 1st and 2nd year grades, if we get the PhD anyway? How important are board scores given that we're MD/PhDs?

In other words, what, besides the PhD and clinical year grades/recommendations, is crucial towards an excellent residency application?

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[antinomian]

An entirely reasonable question, but one without any sort of formulaic prescription (as I'm sure you're aware). What follows is merely my opinion, but one with a reasonably large sample size:

Most important factors (all couched within the context of the reputation of your school/program) in a loosely decreasing order:
Clinical Grades
PhD
Board Scores
Pre-Clinical Grades
Other Stuff

This is entirely generic, and after being around for a while and seeing multiple rounds of med school class matches take place as well, you'll see that mitigating circumstances and outliers abound, so much so that the schema above is very flexible. Finding and connecting with a prominent clinician is a simple way to leapfrog the schema to some degree. Ultimately, residency programs in superior clinical departments want residents who can perform well clinically.

As someone at my program recently pointed out, having an MD/PhD is no longer a golden ticket to the most desirable programs in the most competitive residencies (though it still seems to be in the "bread and butter" residencies - medicine/psych/path). There are many MD/PhDs applying to rads/derm/optho/rad onc, and simply having an MD/PhD is not as meaningful as it once may have been. Tanking the boards, for instance, will be a source of anxiety all the way up until match day, even if you manage to find a chair of a department who really wants to help you out (and you won't know how much that means until you match).

Speaking generally, it seems that people at this program generally don't distinguish themselves in the first two years, still do quite well on the boards, and when they come back to the wards, perform well above average. Maybe 1-3 people per year graduate with AOA. Most people don't do any shadowing/clinical work during their thesis time, but there is plenty of opportunity to do so (one person spent a month working with the neurosurgery team ... he's doing medicine@BWH now...) Given the above two paragraphs it seems that people from my program go where they want.

RE: "extracurrics"
This could mean nearly anything, from singing in your schools inevitably medically-themed A cappella group to touring with your signed band. Starting a health policy interest group to working on national legislature. You get the point. If the magnitude of your skill/activity is great, sure, it'll help. If not, it's a conversation piece at best.

In short, it depends. Your program should have information from it's collective experience. Ask people who are in the process now - they'll be able to give you the state of the art, as it applies to your program. Over the years students here have compiled a pretty comprehensive "underground" guide to the process, and organize information sessions about the various transitions/planning. As a result, most people around here don't stress out about the process and just focus on doing what they want to do. If your school doesn't already do that stuff, then suggest it. An MD/PhD is like a post-graduate Montessori school - take advantage of what the older kids know, and I'm sure they'll be more than happy to impart that information.

 

[Circumflex]

I'm not exactly sure what you mean by course of study - do you mean PhD field? I agree with the previous post and will add some thoughts.

As far as what constitutes an excellent residency application, it depends on what residency you want to do and where you want to do it. Obviously, "excellent" at Harvard may be different from Kansas State, as with Derm vs. Peds.

The first step is choosing your lab - follow your interests and instincts. While in the lab, I would do 1-2 half days of clinical stuff per month. Part of it was to explore different fields and part of it was to keep my medical flame burning. You just have to be careful not to do too much - one of the keys to success in the lab is FOCUS. 3rd year of medical school will help you decide on what residency to pursue.

Like the previous post said, the MD/PhD is not a golden ticket. Board scores can be very important, depending the field and location. Always do your best. Your future is a very personal decision. The same could be said for how you are ranked for residency. There is no magic formula. Once you find a field of medicine, the best thing you can do is to talk with residents and faculty, and find physician-scientists and gather all the input you can regarding your future career choices.

As for extracurriculars, I don't think they make a big difference in the application, but can make for good conversation during the interviews. However, I believe that to keep some balnce and sanity in your life, you should do something outside of medicine/science. And, volunteering is good for the heart and the soul. 1 day a month won't hurt you academically, and it may help.

 

[kassie]

Honestly, without a good step 1 no one will look at the extracurrics if you're shooting for something or somewhere competetive. Do well on step 1 first, then publish, then do well in clinical years. Extracurrics if that isn't too much.

I went through ophtho match last year and my better 1/2 is doing IM now so I speak from personal experience.

 

[Vader]

Along the lines of the OP's questions... how important are publications (i.e. number, journal, etc) in the residency application process for MD/PhDs?

 

[Circumflex]

Along the lines of the OP's questions... how important are publications (i.e. number, journal, etc) in the residency application process for MD/PhDs?

Not very. Remember that you are applying for residency, not a post-doc. The fact that you have a PhD is the main selling point. However, if you are applying to a research-oriented program at a prestigious school, then number/type of publication may be a little more significant, but not much.

 

[dphoenix]

I haven't applied to residency yet but here are the things that seem to be important from my experience with other MD/PhDs who graduated:

Very Important:

1. Publications (measures how productive you are)
2. Clinical grades (you're still a clinician remember?)
3. USMLE Step I (muddphuds better have a damn good reason why they can't score well)

Not important:
Extracuriculars, etc. all the stuff that got you into college/med school

From what I can tell, AOA is a plus but not a deal breaker because of the PhD and also because typically MD/PhDs are going back to clinics after a multiyear break. Being able to keep up with MD gunners is not completely expected.

 

[Circumflex]

I haven't applied to residency yet but here are the things that seem to be important from my experience with other MD/PhDs who graduated:

Very Important:

1. Publications (measures how productive you are)
2. Clinical grades (you're still a clinician remember?)
3. USMLE Step I (muddphuds better have a damn good reason why they can't score well)

Not important:
Extracuriculars, etc. all the stuff that got you into college/med school

From what I can tell, AOA is a plus but not a deal breaker because of the PhD and also because typically MD/PhDs are going back to clinics after a multiyear break. Being able to keep up with MD gunners is not completely expected.

I applied this past Fall and from my experience, Step 1 score is much more important than anything else. Clinical grades don't make or break you unless you fail something. Publications are more important for getting a faculty position. Residencies usually don't care how productive you are in the lab. Publish 1-2 solid papers and you'll be fine.

 

[kassie]

Not very. Remember that you are applying for residency, not a post-doc. The fact that you have a PhD is the main selling point. However, if you are applying to a research-oriented program at a prestigious school, then number/type of publication may be a little more significant, but not much.

Unless you're going for fast track at a great institution...

 

[dl2dp2]

getting down and dirty here,
how high is a "good score" on Step I?

 

[gbwillner]

getting down and dirty here,
how high is a "good score" on Step I?

230+

 

[dphoenix]

I applied this past Fall and from my experience, Step 1 score is much more important than anything else. Clinical grades don't make or break you unless you fail something. Publications are more important for getting a faculty position. Residencies usually don't care how productive you are in the lab. Publish 1-2 solid papers and you'll be fine.

No, I've seen a couple of MD/PhDs not match their top choice because their clinical grades were "just" passing. I've been told that the biggest mistake MD/PhDs make going back is thinking that their extra degree gives them a free pass on the clinics. Remember, the PhD is supposed to be EXTRA to your med school training. Residencies now don't want MD/PhDs who can't keep up to snuff on the clinical side.

Step 1 is very important, true, but is really only to show you're razor sharp academic-wise. I know one person who got a 260+ and matched his third choice because he didn't do well in the clinics.

Publications - granted, 1-2 is fine. A Nature/Science paper is minimally useful. What I really meant before was that you have to publish at least 1 first author paper or it shows you can't cut it in lab.

One Caveat - this is from what I know about my friends applying to competitive specialties. I'm talking about ROAD - as for others like Neuro, Path, IM, you'll probably match 1st choice without much problem

 

[mercaptovizadeh]

Yeah, I'm interested in something like IM and then ID or onc. So I'm not looking to compete for derm.

 

[Circumflex]

No, I've seen a couple of MD/PhDs not match their top choice because their clinical grades were "just" passing.

How do you know this? No one knows for sure why they don't match their top choices - sometimes it comes down to personalities and fitting into a program.

 

[antinomian]

Yeah, I'm interested in something like IM and then ID or onc. So I'm not looking to compete for derm.

Then be sure to maintain a pulse and good humor, and you'll be fine.

 

[chirurgino]

Clinical grades: very important, but not all are necessarily of the same importance. For example, if you're going into something surgical, you'd better get the top grade in your surgery rotation, while your medicine grade will matter much less. Vice versa for medicine. I assume that you won't go into Ob/Gyn, so rest assured that absolutely no one will care about that grade anyway unless you fail. It's cynical, but don't hesitate to play the game of wanting to go into whatever rotation you happen to be on. Sad, but it makes a huge difference.

Pre-clinical grades: virtually no importance--they get like 3 lines in your final Dean's letter which will be at least 2 pages--unless they impact on AOA (see below).

Step I: Somewhat important--but analogous to the MCAT, a 265 won't automatically get you in somewhere, while a 190 might keep you out of some residencies. In general, I think surgical specialties put more weight on Step I.

AOA: Don't know how important for MD-PhDs, and praise the lord my school doesn't have it

Quality of PhD papers: Unless you're applying in rad onc, the vast, vast majority of MDs will have absolutely no idea whether your paper in PNAS vs. Neuron has a higher impact factor, although the Cell/Science/Nature paper will stand out. I think as long as you have 1-2 first author papers and a great letter from your PI, you'll be fine. The PhD itself will put you in a different class from other residency applicants, and I've never heard of a situation where a great publication record "saved" an otherwise mediocre residency application.

Other activities: I did absolutely nothing, including in the 1st 2 yrs of med school, except fulfill my PhD teaching requirement, and I got great interviews. Medicine or peds programs may care that you were still a junior messiah in the 1st 2 yrs of med school (meaning, left-over from college, when we all had to play that game), but the PhD should put you above all that nonsense anyway.

 

[Vader]

Unless you're going for fast track at a great institution...

Yes, tell me more...!

 

[Circumflex]

Yes, tell me more...!

Most, if not all, of the big, research-oriented institutions have fast-track residencies. Most of them are IM and Peds, but more Path programs are popping up (UCSF and UTSW that I know of).

The idea is that you go from med school into a combined residency/fellowship/post-doc. So, you don't have to apply for fellowships. It basically takes 1 year each off of residency and fellowship (many of which are 3 years) and incorporates 2-3 years of a research post-doc at the end. You still have to meet all the board requirements of residency and fellowship, but most incorporate elective time, allowing for consolidation.

Basically, when you apply for residency, you apply for these programs separately. Check out the UCSF Molecular Medicine website. Also, if you search this forum or the Research Residency forum, you can find out more. UAB (don't know the website) has a comprehensive list of IM fast-track programs.

As kassie indicated, these are more competitive than straight residencies.

 

[Maebea]

Here is a link that you might find useful: http://www.physicianscientists.org/Training_Programs/Residency.html

Chirurgino is on target with what residency programs are looking for, though I think he understates the importance of medicine grades for those going into surgery. The accepted wisdom is that strong grades in medicine are desired by the surgical disciplines.

 

[Doctor&Geek]

Basically, when you apply for residency, you apply for these programs separately. Check out the UCSF Molecular Medicine website. Also, if you search this forum or the Research Residency forum, you can find out more. UAB (don't know the website) has a comprehensive list of IM fast-track programs.

As kassie indicated, these are more competitive than straight residencies.

I wrote that website:

http://www.dpo.uab.edu/~paik/rr.html

but the new one at APSA is more complete. I haven't updated my site in several months.

 

[Vader]

Most, if not all, of the big, research-oriented institutions have fast-track residencies. Most of them are IM and Peds, but more Path programs are popping up (UCSF and UTSW that I know of).

The idea is that you go from med school into a combined residency/fellowship/post-doc. So, you don't have to apply for fellowships. It basically takes 1 year each off of residency and fellowship (many of which are 3 years) and incorporates 2-3 years of a research post-doc at the end. You still have to meet all the board requirements of residency and fellowship, but most incorporate elective time, allowing for consolidation.

Basically, when you apply for residency, you apply for these programs separately. Check out the UCSF Molecular Medicine website. Also, if you search this forum or the Research Residency forum, you can find out more. UAB (don't know the website) has a comprehensive list of IM fast-track programs.

As kassie indicated, these are more competitive than straight residencies.

I have always wondered why these programs do not include neurology and psychiatry?